NONFONKSİYONE ADRENAL İNSİDENTALOMALARDA İNSULİN REZİSTANSI VE YENİ İNFLAMATUAR BELİRTEÇLER

Abstract

Amaç: Son dönemlerde, nonfonksiyone adrenal insidentaloma (NFAİ) saptanma sıklığının artması ve bu kitlelerin henüz rutin metodlarla ölçülemeyen bazı aktif metabolitleri salgıladığına dair ciddi kuşkular uyandırması sebebiyle, bu çalışmada NFAİ’lı hastalarda yeni inflamatuvar belirteçler olan ortalama trombosit hacmi (MPV), trombosit dağılım genişliği (PDW), nötrofil/lenfosit oranı (N/L), platelet/lenfosit (P/L) oranı ile insülin resistansı ilişkisinin belirlenmesi amaçlanmıştır.

Gereç ve Yöntemler: Çalışmaya Endokrinoloji polikliniğine başvuran ve NFAİ tanısı konan 60 hasta ve herhangi bir nedenle çekilen üst abdomen bilgisayarlı tomografi (BT)’de adrenal kitlesi olmayan ve herhangi başka patolojiye rastlanmayan 60 sağlıklı kontrol grubu dahil edildi.

Bulgular: Kontrol grubu ile fonksiyonel olmayan adrenal insidentaloma hastaları arasında cinsiyet, yaş, antropometrik ölçümler, açlık plazma glukozu ve lipid profili açısından anlamlı fark yoktu. Ortalama MPV, PDW, N/L oranı, P/L oranı karşılaştırıldığında NFAİ’lı hastalarda sağlıklı kontrol grubuna göre istatistiksel anlamlı fark bulunamadı. NFAİ hastaları, sağlıklı kontrol grubundan daha yüksek açlık insülin seviyesine (p=0.016) ve HOMA-IR düzeylerine sahipti (p=0.01). HOMA-IR ile MPV, PDW, N/L oranı ve P/L oranı arasında hiçbiri ile korelasyon saptanmadı.

Sonuç: NFAİ hastalarda MPV, N/L, P/L oranları gibi yeni ateroskleroz ve subklinik inflamatuvar markerlarda değişiklik olmadığını gösterdik. İnsülin direnci NFAİ hastalarında kontrol grubuna göre daha sık gözlenmektedir ve bu açıdan hastaların yakın takibi gerekmektedir. Bu hastalardaki insülin direncinin fizyopatolojisini açıklayacak daha ileri prospektif çalışmalara ihtiyaç vardır. 

Keywords

• Nonfonksiyone adrenal insidentaloma,ortalama trombosit volumu,trombosit dağılım genişliği,nötrofil/lenfosit oranı,platelet/lenfosit oranı,insülin rezistansı

Insulin Resistance in Nonfunctioning Adrenal Incidentaloma and New Inflammatory Markers

Abstract

Objective: Due to the increase of incidence of nonfunctioning adrenal incidentaloma (NFAI) recently, and the suspicion that these masses secrete some active metabolites that cannot yet be measured by routine methods, we aimed to determine the relationships between insulin resistance and new inflammatory markers such as mean platelet volume (MPV), platelet distribution width (PDW), neutrophil/lymphocyte ratio (N/L), platelet/lymphocyte ratio (P/L) in patients with NFAI in our study.

Material and Methods: Sixty patients admitted to the endocrinology outpatient clinic and diagnosed as NFAI and 60 healthy controls without adrenal mass and no other pathology on upper abdomen computed tomography (CT) for any reason were included in the study.

Results: There were no significant differences between control group and patients with NFAI in terms of gender, age, anthropometric measurements, fasting plasma glucose and lipid profile. The mean MPV, PDW, N/L ratio and P/L ratio were not significantly different between healthy control group and NFAI group. The patients with NFAI had higher fasting insulin level (p=0.016) and higher HOMA-IR value than their healthy control group (p=0.01). There were no correlations between HOMA-IR and MPV, PDW, N/L ratio, P/L ratio.

Conclusion: We demonstrated no difference in new markers of atherosclerosis and systemic inflammation such as MPV, PDW, N/L ratio and P/L ratio in patients with NFAI. Insulin resistance was more frequent in the patients with NFAI than in controls, therefore, close follow-up is required. The further prospective studies to explain the physiopathology of insulin resistance in these patients are needed. 

Keywords

• Nonfunctioning adrenal incidentaloma,mean platelet volume,platelet distribution width,neutrophil/lymphocyte ratio,platelet/lymphocyte ratio,insulin resistance

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